Case Study: Healthcare Provider Fees and Medical Insurer Reimbursement « Allied Health World Blog

Case Study: Healthcare Provider Fees and Medical Insurer Reimbursement

About a year ago I received a medical bill following a routine visit to the doctor for my two year-old daughter. Usually I only have to pay a small co-pay of about $7 after each visit. Unfortunately, there was a discrepancy by my insurance company and they denied the insurance claim made by the pediatrician.

Without health insurance the bill for that visit was $500. After rectifying the mistake made by my insurance company, the claim eventually went through and I did not have to pay more than my regular co-pay. Why am I bothering to share this story with you? I learned a valuable bit of information about healthcare provider fees and medical insurer reimbursement from this experience.

Insurance companies negotiate reimbursement fees with healthcare providers. These fees can be substantially less than the amount a person without insurance would have to pay. From my own experience, my insurance company negotiated with my provider to pay less than half of his regular fees. This is one reason why it pays to pay for health insurance.

Health insurance companies are very particular buyers. They do their research to ensure that they are not paying more than the fair market price for a product or service. The health care market is carefully monitored. Healthcare providers from around the country are surveyed to determine what the average fee is for each procedure. The information that is gathered is used to set the reimbursement fees to healthcare providers.

If you do not have health insurance you will certainly pay more than necessary for the same quality of care. Unless you are a very healthy person, the risk of going without health insurance may cost too much.